脊髓损伤早期手术及康复训练的疗效分析

Therapeutic effect of early surgery and rehabilitation training on acute spinal cord injury

目的介绍脊髓损伤早期脊髓探查和脊髓软化切开手术的术式和术后步行训练方法并分析其疗效。方法对40例完全性脊髓损伤30 d内的患者行脊柱脊髓损伤早期联合手术方式:一次性完成椎体内固定、松解硬脊膜下粘连、脊髓内外彻底清创减压,从而减轻脊髓二次损伤,保护神经细胞和残存神经纤维;术后辅以个体化脊柱固定减负背心,开展伤后早期康复训练;术后进行6个月的定期脊髓功能评价。结果术中术后未发生手术部位大出血、感染、残损加重等并发症。术后6个月,美国脊柱损伤协会(ASIA)残损分级A级17例、B级5例、C级11例、D级7例。ASIA评分:平均运动提高16.7分、针刺觉提高10.32分、轻触觉提高11.52分。结论在脊髓损伤早期行脊髓探查和脊髓软化切开手术是安全有效的,可恢复部分患者的部分脊髓功能。

Objective To introduce a novel operative type of early exploratory durotomy and rehabilitation training method for acute spinal cord injury,and to analyze the effect.Methods A total of 40 patients with complete spinal cord injury within 30 d were collected and treated with the new combined operation methed,including vertebral internal fixation,intradural adhesion lysis,internal and external spinal cord decompression,which could decrease the secondary injury of the cord and protect the neurons and nerves fibers.Postoperative rehabilitation training was performed at early stage with immobilizing vest.And spinal cord function assessment was carried out 6 months after the operation.Results Complications including massive hemorrhage,infection and impairment aggravation did not occur during and after the operation.According to American Spinal Injury Association（ASIA） impairment scale,there were 17 cases of grade A,5 cases of grade B,11 cases of grade C and 7 cases of grade D 6 months after the operation.ASIA scores were increased by 16.7 in average in motor,10.32 in pin prick and 11.52 in light touch.Conclusion It is safe and effective to perform early exploratory durotomy,which improves part of spinal cord functions in some patients.